Refluxsymptomatik – kein Unterschied in Ausprägung und Schweregrad bei Patienten mit und ohne funktionell bewiesene gastroösophageale Refluxerkrankung

Zusammenfassung

Hintergrund Patienten mit gastroösophagealem Reflux (GERD) leiden oft sehr unter der Symptomatik. Im Rahmen unserer Studie galt es deshalb herauszufinden, ob sich die Lebensqualität und die Symptome bei Patienten mit objektiv nachgewiesener GERD von Patienten ohne funktionell bewiesenes Korrelat unterscheidet.

Material und Methoden Eingeschlossen wurden alle Patienten mit typischer Refluxsymptomatik, die 2017 an unserer Abteilung für Allgemein-, Viszeral- und Thoraxchirurgie hinsichtlich des Vorliegens einer GERD abgeklärt wurden. Alle Patienten erhielten eine hochauflösende Manometrie, 24-h-Impedanz-pH-Metrie und eine Gastroskopie. Die Lebensqualität wurde mittels Quality of Life Index (GIQLI) und die gastrointestinale Symptomatik mittels einer Symptomcheckliste (SCL) evaluiert. Mittels SCL wurde die Schwere und Intensität von 14 verschiedenen Symptomen eruiert. Basierend auf den Resultaten der 24-h-pH-Impedanzmessung wurden die Patienten in 2 Gruppen eingeteilt – Patienten mit gastroösophagealer Refluxerkrankung und Patienten mit rein funktioneller Symptomatik ohne organisches Korrelat. Diese Gruppen wurden miteinander verglichen.

Ergebnisse Ein vollständiger Datensatz war bei 162 Patienten verfügbar, wovon 86 Patienten (52,2%) objektiv an Reflux erkrankt waren (DeMeester-Mittelwert: 37,85; SD ± 29,11) und 76 Patienten (46,1%) einen unauffälligen DeMeester-Score (Mittelwert: 7,01; SD ± 4,09) aufwiesen. Zwischen diesen beiden Gruppen konnte kein signifikanter Unterschied in der Lebensqualität gefunden werden (Mittelwert GIQLI von GERD-Patienten: 94,81; SD ± 22,40; Mittelwert GIQLI von Patienten mit rein funktionellen Symptomen: 95,26; SD ± 20,33; p = 0,988). Außerdem konnte kein signifikanter Unterschied in der Symptomwahrnehmung der Patienten gefunden werden (Mittelwert SCL-Score von Refluxpatienten: 46,97; SD ± 29,23; Mittelwert SCL-Score bei Patienten mit rein funktioneller Symptomatik 48,03; SD ± 29,17; p = 0,827).

Schlussfolgerung Patienten mit funktionellen Refluxbeschwerden unterscheiden sich hinsichtlich des Leidensdrucks nicht von Patienten mit objektiv bewiesener Refluxerkrankung. Eine Differenzierung zwischen gastroösophagealer Refluxerkrankung und funktionellen Refluxsymptomen ist nur mittels Funktionsdiagnostik möglich.

Abstract

Background Patients with gastroesophageal reflux disease (GERD) often suffer greatly from their symptoms. The aim of this study was to determine if there is a difference in quality of life and gastrointestinal symptom complexes between patients with purely functional complaints and patients with objective GERD.

Material and Methods We included all patients with typical reflux symptoms, who had a GERD examination in 2017 at our department. All patients underwent high resolution manometry, 24-h-pH-metry impedance measurement and gastroscopy. Quality of life was assessed using the Gastrointestinal Quality of Life Index (GIQLI) and gastrointestinal symptoms were rated by a symptom checklist (SCL), assessing the severity and intensity of 14 different symptoms. Based on the results of the 24-h-pH-metry impedance measurement, patients were divided into 2 groups: patients with functional reflux symptoms and patients with true GERD. These two groups were compared.

Results Complete data were available in 162 patients, of whom 86 (52.2%) were objectively suffering from reflux (DeMeester score mean: 37.85; SD ± 29.11) and 76 (46.1%) had a normal DeMeester score (Mean: 7.01; SD ± 4.09). No significant difference in quality of life was found between the two groups (mean GIQLI of GERD patients: 94.81, SD ± 22.40, and mean GIQLI of patients with functional reflux symptoms: 95.26, SD ± 20.33, p = 0.988). Furthermore, no significant difference could be found in the evaluated symptoms (mean general SCL score of GERD patients: 46.97; SD ± 29.23; patients with functional reflux symptoms: 48.03; SD ± 29.17, p = 0.827).

Conclusion Patients with functional complaints suffer just as much from their symptoms as patients with objectively diagnosed GERD. Differentiation between gastroesophageal reflux disease and functional reflux symptoms is only possible by means of functional diagnostic testing.

Schlüsselwörter

gastroösophageale Refluxerkrankung - Lebensqualität - Funktionsdiagnostik - funktionelle Refluxsymptome

Key words

gastroeosophageal reflux disease (GERD) - diagnostics - quality of life - functional reflux symptoms

Publication History

Article published online:
08 February 2021

• Literatur

• 1 Hom C, Vaezi MF. Extraesophageal manifestations of gastroesophageal reflux disease. Gastroenterol Clin North Am 2013; 42: 71-91
• 2 Vakil N, van Zanten SV, Kahrilas P. et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006; 101: 1900-1920
• 3 El-Serag HB, Sweet S, Winchester CC. et al. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2014; 63: 871-880
• 4 Ayazi S, Hagen JA, Chan LS. et al. Obesity and gastroesophageal reflux: quantifying the association between body mass index, esophageal acid exposure, and lower esophageal sphincter status in a large series of patients with reflux symptoms. J Gastrointest Surg 2009; 13: 1440-1447
• 5 Klauser AG, Schindlbeck NE, Müller-Lissner SA. Symptoms in gastro-oesophageal reflux disease. Lancet 1990; 335: 205-208
• 6 Klauser AG, Voderholzer WA, Knesewitsch PA. et al. What is behind dyspepsia?. Dig Dis Sci 1993; 38: 147-154
• 7 Holtmann G, Gschossmann J, Neufang-Hüber J. et al. Differences in gastric mechanosensory function after repeated ramp distensions in non-consulters with dyspepsia and healthy controls. Gut 2000; 47: 332-336
• 8 Kandulski A, Moleda L, Müller-Schilling M. Diagnostic Investigations of Gastroesophageal Reflux Disease: Who and When to Refer and for What Test?. Visc Med 2018; 34: 97-100
• 9 Numans ME, Lau J, de Wit NJ, Bonis PA. Short-term treatment with proton-pump inhibitors as a test for gastroesophageal reflux disease: a meta-analysis of diagnostic test characteristics. Ann Intern Med 2004; 140: 518-527
• 10 Gyawali CP, Kahrilas PJ, Savarino E. et al. Modern diagnosis of GERD: the Lyon Consensus. Gut 2018; 67: 1351-1362
• 11 Zhang L, Tu L, Chen J. et al. Health-related quality of life in gastroesophageal reflux patients with noncardiac chest pain: Emphasis on the role of psychological distress. World J Gastroenterol 2017; 23: 127-134
• 12 Wiklund I, Carlsson J, Vakil N. Gastroesophageal reflux symptoms and well-being in a random sample of the general population of a Swedish community. Am J Gastroenterol 2006; 101: 18-28
• 13 Eypasch E, Williams JI, Wood-Dauphinee S. et al. Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg 1995; 82: 216-222
• 14 Fuchs KH, Feussner H, Bonavina L. et al. Current status and trends in laparoscopic antireflux surgery: results of a consensus meeting. The European Study Group for Antireflux Surgery (ESGARS). Endoscopy 1997; 29: 298-308
• 15 Koch OO, Kaindlstorfer A, Antoniou SA. et al. Subjective and objective data on esophageal manometry and impedance pH monitoring 1 year after endoscopic full-thickness plication for the treatment of GERD by using multiple plication implants. Gastrointest Endosc 2013; 77: 7-14
• 16 Patel DA, Harb AH, Vaezi MF. Oropharyngeal Reflux Monitoring and Atypical Gastroesophageal Reflux Disease. Curr Gastroenterol Rep 2016; 18: 12
• 17 Wilhelm D, Jell A, Feussner H. et al. Pharyngeal pH monitoring in gastrectomy patients – what do we really measure?. United European Gastroenterol J 2016; 4: 541-545
• 18 Farhath S, He Z, Nakhla T. et al. Pepsin, a marker of gastric contents, is increased in tracheal aspirates from preterm infants who develop bronchopulmonary dysplasia. Pediatrics 2008; 121: 253-259
• 19 Stovold R, Forrest IA, Corris PA. et al. Pepsin, a biomarker of gastric aspiration in lung allografts: a putative association with rejection. Am J Respir Crit Care Med 2007; 175: 1298-1303
• 20 Kahrilas PJ, Bredenoord AJ, Fox M. et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 2015; 27: 160-174
• 21 Wiklund I. Review of the quality of life and burden of illness in gastroesophageal reflux disease. Dig Dis 2004; 22: 108-114
• 22 Wahlqvist P, Karlsson M, Johnson D. et al. Relationship between symptom load of gastro-oesophageal reflux disease and health-related quality of life, work productivity, resource utilization and concomitant diseases: survey of a US cohort. Aliment Pharmacol Ther 2008; 27: 960-970
• 23 Tack J, Becher A, Mulligan C. et al. Systematic review: the burden of disruptive gastro-oesophageal reflux disease on health-related quality of life. Aliment Pharmacol Ther 2012; 35: 1257-1266
• 24 Forootan M, Zojaji H, Ehsani MJ. et al. Advances in the Diagnosis of GERD Using the Esophageal pH Monitoring, Gastro-Esophageal Impedance-pH Monitoring, And Pitfalls. Open Access Maced J Med Sci 2018; 6: 1934-1940
• 25 Drossman DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology 2016; DOI: 10.1053/j.gastro.2016.02.032.
• 26 Aziz Q, Fass R, Gyawali CP. et al. Functional Esophageal Disorders. Gastroenterology 2016; DOI: 10.1053/j.gastro.2016.02.012.
• 27 Hsu CS, Wen SH, Hung JS. et al. Overlap of Dyspepsia in Patients with Gastroesophageal Reflux Disease: Impact of Clinical, Metabolic, and Psychosocial Characteristics. Dig Dis Sci 2017; 62: 994-1001
• 28 Galmiche JP, Hatlebakk J, Attwood S. et al. Laparoscopic antireflux surgery vs. esomeprazole treatment for chronic GERD: the LOTUS randomized clinical trial. JAMA 2011; 305: 1969-1977
• 29 Frazzoni M, Piccoli M, Conigliaro R. et al. Refractory gastroesophageal reflux disease as diagnosed by impedance-pH monitoring can be cured by laparoscopic fundoplication. Surg Endosc 2013; 27: 2940-2946
• 30 Pauwels A, Boecxstaens V, Andrews CN. et al. How to select patients for antireflux surgery? The ICARUS guidelines (international consensus regarding preoperative examinations and clinical characteristics assessment to select adult patients for antireflux surgery). Gut 2019; 68: 1928-1941
• 31 Viazis N, Keyoglou A, Kanellopoulos AK. et al. Selective serotonin reuptake inhibitors for the treatment of hypersensitive esophagus: a randomized, double-blind, placebo-controlled study. Am J Gastroenterol 2012; 107: 1662-1667